- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.29 / $556.25 / $2,944.57
| Professional | | $383.29 | $556.25 | $2,944.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.11 / $909.11 / $909.11
| Facility | | $909.11 | $909.11 | $909.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.40 / $809.56 / $1,401.89
| Professional | | $464.40 | $809.56 | $1,401.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.22 / $664.34 / $877.91
| Facility | | $530.22 | $664.34 | $877.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.10 / $926.88 / $1,544.52
| Professional | | $556.10 | $926.88 | $1,544.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.34 / $882.36 / $1,179.40
| Professional | | $738.34 | $882.36 | $1,179.40 |